Emergency Imaging in Ocular Trauma
Summarized by: Sakib Kazi, M.D.
Reviewed by: Elton Law, M.D.
Original publication details
Authors: Jarett Thelen, Asha A Bhatt, Alok A Bhatt
DOI: 10.1007/s10140-017-1528-0
Reference: Thelen, J., Bhatt, A. A., & Bhatt, A. A. (2017). Acute ocular traumatic imaging: what the radiologist should know [corrected]. Emergency radiology, 24(5), 585–592.
Imaging modalities
CT: Initial modality for emergent orbital injuries
US and MR can be used but have their respective limitations
US is operator dependent
MR can provide greater soft tissue resolution at the cost of time and contradiction with metallic foreign bodies
Anterior chamber trauma
Traumatic hyphema can appear as high attenuation material/clot in the anterior chamber
Corneal laceration can appear as a significant loss of anterior chamber volume
Lens trauma
Lens dislocation or subluxation. Note that in rare cases patients may have chronically dislocated lens from prior trauma or connective tissue diseases.
Traumatic cataract can appear as decreased attenuation of affected lens.
Posterior segment trauma
Choroid detachment (biconvex shape)
Retinal detachment (V-shaped converging towards optic disc)
Vitreous hemorrhage
Intraocular foreign bodies
Metals: Very high attenuation
Glass: Relatively highly attenuating between 300-500 HU typically, but may be less dense depending on the type of glass
Wood: May have low attenuation mimicking air or may have similar attenuation to surrounding soft tissues
— MR can be used for further assessment as wood is usually hypointense on T1 and T2
Open globe injury
Globe rupture can appear as globe deformity and/or loss of volume
— Intraocular foreign body or gas implies penetration & rupture of the globe
This should be suspected with any significant scleral or corneal laceration
Citation
Thelen, J., Bhatt, A. A., & Bhatt, A. A. (2017). Acute ocular traumatic imaging: what the radiologist should know [corrected]. Emergency radiology, 24(5), 585–592. https://doi.org/10.1007/s10140-017-1528-0